MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The well known potentially lethal complications of anti-thrombotic medications of cerebral and gastrointestinal bleeding complications are well known. However, more common bleeding related complications are not well described . In particular, gross hematuria is a well known complication of these medications but its frequency and severity is unknown. We sought to characterize this association among a large population-based cohort consisting of over 2.5 million patients from the Province of Ontario, Canada, using hematuria-related complications was endpoints. These were defined as undergoing invasive urologic procedures, hospital admissions or emergency visits for gross hematuria.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Blood thinning (antiplatelets) drugs reduce further strokes (recurrence) after stroke and mini-stroke (TIA). One antiplatelet, such as aspirin, is better than none, and two different drugs are better than one. The question then is whether three would be better still, providing excess bleeding is not problematic.

3096 patients with ischaemic stroke (stroke due to a blood clot) or mini-stroke were enrolled within 48 hours. They were randomised to take intensive separate antiplatelet therapy (three drugs comprising aspirin, clopidogrel and dipyridamole) or guideline therapy (either clopidogrel alone, or combined aspirin and dipyridamole) for 30 days (after which they took guideline treatment). At 90 days we assessed whether patients had had another stroke or mini-stroke, and how dependent or disabled this had left them.

There were slightly fewer recurrent strokes and mini-strokes between intensive and guideline treatment but the difference was not different statistically, so a neutral trial. In contrast, major bleeding was significantly increased in the intensive group as compared with guideline treatment. When looking at the net benefit/harm, there was no difference between the treatment groups.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cangrelor is a potent, fast on, fast off, intravenous ADP receptor antagonist that is now available for use during PCI. Glycoprotein IIb/IIIa inhibitors are intravenous antiplatelet agents that work by a different mechanism. Doctors have asked whether there is any advantage to combining them or whether one class is preferable to the other during PCI.

We analyzed close to 25,000 patients from the CHAMPION trials. Cangrelor’s efficacy in reducing peri-procedural ischemic complications in patients undergoing PCI was present
irrespective of glycoprotein IIb/IIIa inhibitor administration. However, glycoprotein IIb/IIIa inhibitor use resulted in substantially higher bleeding rates, regardless of whether the patient was randomized to cangrelor or to clopidogrel.

Thus, in general, cangrelor and glycoprotein IIb/IIIa inhibitors should not routinely be combined. If an operator wishes to use a potent intravenous antiplatelet during PCI, cangrelor is similarly efficacious as glycoprotein IIb/IIIa inhibitors, but with less bleeding risk.

Richard A. Bernstein MD, PhDDirector, Northwestern Stroke Program
Professor of Neurology
Feinberg School of Medicine of Northwestern University

Medical Research: What is the background for this study?

Dr. Bernstein: Patients on blood thinners, including dabigatran, have an increased risk of bleeding including in the brain. We believe that reversing the blood thinning effects of dabigatran in the setting of bleeding might improve outcome by helping the bleeding to stop.

Medical Research: What are the main findings?

Dr. Bernstein: We found that in 18 patients taking dabigatran with intracranial bleeding, Idarucizumab completely and nearly instantaneously reversed the blood thinning effect of dabigatran.

Medical Research: What should clinicians and patients take away from your report?

Dr. Bernstein: Patients taking dabigatran with intracranial bleeding can have the anticoagulant effect of dabigatran rapidly and completely reversed with Idarucizumab.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Bernstein: My presentation is derived from a cohort of the first 90 patients enrolled in reverse-AD. We will publish a similar analysis from the complete reverse ad cohort of 500 patients when we are finished enrolling.

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